精神科心理健康护士从业者在公共行为健康服务中的利用和经济贡献。
Utilization and Economic Contribution of Psychiatric Mental Health Nurse Practitioners in Public Behavioral Health Services.
机构信息
Department of Social and Behavioral Sciences, School of Nursing, University of California, San Francisco, San Francisco, California.
Department of Community Health Systems, School of Nursing, University of California, San Francisco, San Francisco, California.
出版信息
Am J Prev Med. 2018 Jun;54(6 Suppl 3):S243-S249. doi: 10.1016/j.amepre.2018.01.045.
INTRODUCTION
Expanded insurance coverage through the Affordable Care Act and parity in behavioral health coverage have increased demand for services. Yet there is a persistent shortage in the behavioral health workforce. Psychiatric Mental Health Nurse Practitioners (PMHNPs) may be part of the solution to shortages but are not yet fully utilized. The purpose of this study was to describe how PMHNPs are utilized, identify barriers to full utilization, and assess PMHNPs' economic contribution in public behavioral health systems.
METHODS
This study used a mixed methods approach, selecting counties for use of PMHNPs, geography, population size, rural/urban, and availability of financial data. The authors conducted 1- to 2-day site visits in 2014-2015 including semi-structured interviews with management and clinical leaders and collected PMHNP staffing and billing data. Thematic analysis of interview data was conducted and aggregate staffing and billing data were analyzed to determine net PMHNP financial contribution.
RESULTS
The primary billed service for PMHNPs is medication management. Barriers to full utilization included system-level barriers to hiring PMHNPs, lack of role-appropriate job descriptions, confusion related to scope of practice/supervision requirements, and challenges in recruitment and retention. Fiscal analysis showed a positive net contribution from PMHNP services.
CONCLUSIONS
PMHNPs can make a significant contribution to behavioral healthcare delivery, particularly in public mental health settings, yet greater understanding of their role and addressing barriers to practice is needed.
SUPPLEMENT INFORMATION
This article is part of a supplement entitled The Behavioral Health Workforce: Planning, Practice, and Preparation, which is sponsored by the Substance Abuse and Mental Health Services Administration and the Health Resources and Services Administration of the U.S. Department of Health and Human Services.
简介
平价医疗法案扩大了保险覆盖范围，行为健康保险覆盖范围实现均等化，这增加了对服务的需求。然而，行为健康劳动力仍然存在短缺。精神科执业护士（PMHNP）可能是解决短缺问题的一部分，但尚未得到充分利用。本研究的目的是描述 PMHNP 的使用情况，确定充分利用的障碍，并评估公共行为健康系统中 PMHNP 的经济贡献。
方法
本研究采用混合方法，根据 PMHNP 的使用情况、地理位置、人口规模、城乡分布和财务数据的可用性选择县。作者于 2014-2015 年进行了为期 1-2 天的现场访问，包括对管理层和临床负责人进行半结构化访谈，并收集 PMHNP 人员配备和计费数据。对访谈数据进行主题分析，并对汇总的人员配备和计费数据进行分析，以确定 PMHNP 的净财务贡献。
结果
PMHNP 的主要计费服务是药物管理。充分利用的障碍包括招聘 PMHNP 的系统障碍、缺乏适当的职位描述、与实践范围/监督要求相关的混淆，以及在招聘和留用方面的挑战。财务分析显示 PMHNP 服务有积极的净贡献。
结论
PMHNP 可以对行为医疗保健服务做出重大贡献，特别是在公共心理健康环境中，但需要进一步了解他们的角色，并解决实践中的障碍。
补充信息
本文是题为“行为健康劳动力：规划、实践和准备”的补充文章的一部分，该补充由美国卫生与公众服务部下属的物质滥用和精神健康服务管理局以及卫生资源和服务管理局赞助。
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